Provider Demographics
NPI:1588671440
Name:BOWER, JAMES CHARLES JR (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:CHARLES
Last Name:BOWER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6063
Mailing Address - Fax:904-539-4091
Practice Address - Street 1:7720 US HIGHWAY 98 W STE 110
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-7231
Practice Address - Country:US
Practice Address - Phone:850-267-1603
Practice Address - Fax:850-622-3342
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME166568207RC0000X
NC200000366207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1588671440Medicaid
P00212232OtherRAILROAD MEDICARE
NC89126UKMedicaid
SCN00366Medicaid
NC126UKOtherBCBS
NC89126UKMedicaid
SCN00366Medicaid
P00212232OtherRAILROAD MEDICARE
NC2280636CMedicare PIN